Our performance

In 2009/10 we reviewed our annual planning framework with a specific focus on developing a set of three year strategic objectives each with a series of executive-led critical workstreams and actions to ensure close monitoring and successful delivery.

Our well established goals of Zero Harm, No Waste and No Waits underpin our objectives which run, like a thread, through every part of the organisation and inform everything we do.

Our seven key strategic objectives focus on:

• Clinical outcomes
• Patients, families and referrers’ experience
• Clinical growth
• Research
• Education and training partnership
• Financial stability
• Corporate needs

Our Annual plan and its delivery is part of a rolling three year programme that is subject to regular strategic review. We have formally set out to support our planning process with a performance management framework designed to ensure that it encompasses:

• Clinical quality and safety indicators, benchmarked where appropriate, focussed on improved performance
• Emphasis on identification of risks
• Identification of breaches to standards or targets
  
• Identification of appropriate management action

Details of our 2011/12 Annual Plan

Key performance measures

The Department of Health (DH) introduced the NHS Performance Framework in 2009 to provide an assessment of the performance of NHS providers (that are not yet NHS Foundation Trusts) against a set of minimum standards. The Performance Framework identifies poor performance on an ongoing basis using a series of indicators to trigger intervention as required.

In 2010/11 we achieved all inpatient and outpatient waiting time and access standards.

• 97 per cent of patients cared for as outpatients waited less than 18 weeks from referral to treatment (target 95 per cent)
• 94 per cent of all patients who were admitted electively for their treatment waited less than 18 weeks from referral to treatment (target 90 per cent)
• We achieved all of the national cancer waiting times standards applicable to specialist paediatric hospitals

In terms of infection control we reported one case of MRSA in year against a year trajectory of two.

We reported 11 cases of C.difficile over the year against a locally agreed low trajectory of nine. The Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) will be presenting our opinion on the relevance of this standard for specialist paediatric hospitals soon.

High quality and effective care

We also firmly believe that providing high quality care provided in a timely manner delivers cost effective care. We aim to give every patient the right high quality treatment first time every time.

We have been working with Dr Foster Intelligence to benchmark the efficiency of our services in four of our priority specialties against our English peers. We analysed the percentage of spells of care with excess bed days, length of stay and readmission rates in our cardiac, neurosurgery, general and spinal surgery services.

The following table is a summary of the results:

Indicator	Cardiac Surgery	General Surgery	Neurosurgery	Spinal Surgery
Excess bed days	Better Than Average (0.56)	Better Than Average (0.73)	Best (0.57)	NA
Length of stay	Best (0.61)	Better Than Average (0.83)	Best (0.67)	Best (0.79)
Readmission rates	Average (1.01)	Best (0.74)	Best (0.72)	Worse Than Average (1.09)

The figures in brackets represent the GOSH ratio against the mean – lower than one is better than average.

For the 11 indicators shown above, GOSH is the best performing in six, better than average in three, average in one and below average in one.

As an example, if all cardiac surgery providers delivered the same length of stay as GOSH then England would need approx 50 less beds for this specialty, given that centres generally have less than 15 beds allocated to paediatric cardiac surgery this would remove the need for at least three centres in the NHS (if other resources were available – such as theatres).

Over the next few years we intend to improve our efficiency throughout the organisation by moving patients’ treatments to their appropriate least acute environment and ensuring that patients do not experience delays and flow in a timely manner. We have started to model a modest amount of this improvement but we aim to achieve a considerable amount more. Below are some examples of what we have modelled, many of which represent savings for commissioners.

We undertake numerous follow up outpatients by telephone and is continuously transferring more follow ups from clinic to telephone. The table below shows our year on year plans to expand this service;

Year	2010/11	2011/12	2012/13	2013/14	2014/15	2015/16
No. telephone outpatients	7,725	8,408	8,909	9,416	9,977	10,612

We are committed to streamlining patient pathways and improving key performance metrics of this such as new to follow up outpatient ratios. The table below shows the planned trajectory of the hospital’s new to follow up ratio over the next 5 years:

Year	2010/11	2011/12	2012/13	2013/14	2014/15	2015/16
New to follow up ratio	4.48	4.39	4.35	4.34	4.34	4.34

We are planning to develop telemedicine clinics in a number of specialties to reduce both patient and clinician travel time and costs.

We have an established programme to undertaken a greater proportion of inpatient gastroenterology activity as day cases. The changing proportions are shown in the table below:

Year	2010/11	2015/16
Day Case Spells	614	799
Non Day Case Elective Spells	897	1,079
% Day Case	68%	74%

Across the organisation we have plans in many specialties to reduce length of stay. The table below outlines the expected number of bed days we will save from current working practices.

Year	2011/12	2012/13	2013/14	2014/15	2015/16
Bed days saved	563	1,120	1,624	2,209	2,883

Find out more about how we comply.